ATI RN
ATI Nur 175 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse is assigned to care for four clients. Which client should the nurse assess first?
Correct Answer: D
Rationale: While it is important to prepare the postoperative client for discharge and ensure they understand how to take their new medication, this situation is less urgent than addressing a potential respiratory issue. Changing the dressing on a recent surgical incision is part of routine care and can be scheduled after more urgent needs are addressed. The client’s wound care is important, but it does not take precedence over potential respiratory distress. Although the chest x-ray is necessary to confirm the correct placement of the nasogastric tube, this can be done after the more immediate concern of a respiratory issue is addressed. The nasogastric tube will remain in place for feeding or drainage in the meantime. This client should be assessed first because asthma can lead to respiratory distress or an asthma attack, which requires prompt intervention. Since the client requested a nebulizer treatment during the previous shift, it is crucial to assess their current respiratory status and administer the treatment if necessary to prevent any complications.
Question 2 of 5
When planning the delegation of tasks to assistive personnel (AP), a nurse considers the five rights of delegation. Which element regarding the role of assistive personnel should the nurse consider when delegating tasks?
Correct Answer: B
Rationale: The ability to prioritize is important for the overall management of tasks, but it is not the most critical factor when considering the delegation of specific tasks to assistive personnel. The knowledge and skill to perform the task is crucial when delegating tasks to assistive personnel. Ensuring that the AP has the appropriate training and competence to carry out the task safely and effectively is essential to maintaining high standards of care. Rapport with clients is important for building trust and effective communication, but it is secondary to having the necessary skills and knowledge to perform delegated tasks. While the ability to complete the task without assistance is beneficial, it is more important that the assistive personnel have the required knowledge and skills to perform the task correctly and safely.
Question 3 of 5
What is the purpose of a black box warning on medication labels?
Correct Answer: B
Rationale: Black box warnings highlight serious, potentially life-threatening risks.
Question 4 of 5
The nurse is working on the neurological unit. Which task would be most appropriate to delegate to the unlicensed assistive personnel assigned to the unit?
Correct Answer: B
Rationale: Administering tube feedings to a quadriplegic client is a task that typically requires specialized training and knowledge to ensure it is performed safely and correctly. This task is often reserved for licensed nursing personnel due to the potential complications that can arise, such as aspiration or incorrect tube placement.
Therefore, it is not appropriate to delegate this task to unlicensed assistive personnel (UAP). Assisting with bowel training by placing the client on the bedside commode is an appropriate task to delegate to unlicensed assistive personnel. This task involves providing physical assistance and support to the client, which falls within the scope of practice for UAP. It does not require specialized nursing knowledge or skills, making it suitable for delegation. Observing the client demonstrating a self-catheterization technique is a task that requires clinical judgment and assessment skills to ensure the client is performing the procedure correctly and safely. This responsibility is typically within the scope of practice for licensed nurses rather than UAP. Teaching Crede's maneuver to a client needing to void involves providing instruction and education on a specific technique to assist with bladder emptying. This teaching role requires specialized knowledge and skills, making it more appropriate for licensed nursing personnel. It is not suitable for delegation to UAP.
Question 5 of 5
A nurse is assessing a client who has respiratory acidosis. Which of the following findings should the nurse expect?
Correct Answer: D
Rationale: COâ‚‚ retention in respiratory acidosis causes CNS depression, leading to lethargy.